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Faculty of Health Sciences School of Physiotherapy 9303432y goundes@therapy.wits.ac.za / Orthopaedic manipulative therapy (OMT) like other areas of physiotherapy, is a rapidly advancing field. To keep abreast of changes, curricula need regular evaluation and updating. The curriculum consists of many components that may vary from content to timetabling. The aim of this study was to determine how past graduates from the University of the Witwatersrand perceived the OMT curriculum with regards to content, teaching methods and clinical learning. This information will contribute to an overall evaluation of the present OMT curriculum. The sample consisted of graduates from 1997-1999. Questionnaires and interviews were used to gather the information. Some interviews were carried out following analysis of answers to the questionnaire to clarify issues or gain additional information. Results indicated that eighty one percent of the sample found the content relevant to clinical practice, but forty two percent found certain aspects of the content inadequate. The following areas of content were deficient: sixty percent found information on patient education, advice and counseling related to OMT inadequate. Fifty five percent would have liked to be more exposed to research in this area. Sixty seven percent felt that teaching of clinical reasoning skills was lacking. Ninety four percent would have liked information on other joint mobilization concepts. It was perceived that active learning methods were more effective than passive learning methods. Fifty eight percent found tutorials, sixty eight percent found practical sessions, and fifty eight percent found workshops very effective. With regards to clinical learning, seventy seven percent found supervision very helpful in clinical placements. Eighty one percent found patient presentations helpful, and seventy one percent found discussion of patients with lecturers very helpful. Most responses indicated that the OMT curriculum was relevant to current practice in South Africa but inadequate in certain specific areas.

Master of Science in Veterinary Science / Developmental Orthopaedic Disease (DOD) describes problems affecting the limbs of young horses, including abnormal bone, joint and tendon development. DOD is responsible for major economic losses in the Thoroughbred industry. Investigation into the epidemiology of DOD in Australia and Ireland as described in this thesis has allowed valuable comparisons and recommendations to be made between the studs in these countries. The project described in this thesis commenced in 1999, with the aim to: a) Establish the incidence of DOD on a stud in Australia and to compare this with similar data for a stud in Ireland b) To determine relationships between factors affecting severity and incidence of DOD in foals with respect to the country in which they are bred and raised c) To further identify risk factor areas associated with the development of DOD Records of 1717 mares from a major stud in Ireland and another in Australia were made available. Foal weight, age of mare, condition of mare, foal sire and date of birth were monitored over two years. The occurrence of DOD was recorded against these data. The incidence of DOD was found to be higher on the stud in Australia (average 49.85%) than on the stud in Ireland (average 14%). Foal weight was found to be a significant factor affecting DOD, with heavier foals showing a proportionally higher severity of the problem. The Australian stud had a higher incidence of DOD in 2000 compared to 1999 (65.2% affected vs 32.1% in 1999), whereas the Irish stud had a lower incidence in 1999 compared to 2000 (11.8% affected vs 16.2% in 2000). The dramatic increase in the incidence of DOD in Australian foals over the 1999-2000 period is representative of the increase in a major problem in the industry, as well as greater awareness of the problem over recent years. It highlights the urgent need for further research into understanding the cause(s) of DOD. Overall recommendations arising from the study include that a large scale, long term study be undertaken in Australia. Further investigation into the nutrition of horses in Ireland and Australia would be of great usefulness in understanding DOD, as would possible genetic links. An issue requiring attention is that of developing a standard definition of the disorder. Considering the wide range of disorders which may fit under the umbrella term DOD, a clear definition is of great importance. The incidence of DOD on one large farm in Ireland was found to be currently low and stable relative to its another large stud farm in Australia. This is a significant finding as the genetic pool of the horses share similarities on both farms, particularly as stallions shuttling between hemispheres sire many foals on both farms. Thus, the data provided herein provide an excellent basis for further valuable comparative studies investigating DOD in foals with a similar genetic background but subjected to differing environmental conditions.

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

2D-3D registration is one of the underpinning technologies that enables image-guided intervention in computer-assisted orthopaedic surgery (CAOS). Preoperative 3D images and surgical plans need to be mapped to the patient in the operating room before they can be used to augment the surgical intervention, and this task is generally fulfilled by using 2D-3D registration which spatially aligns a preoperative 3D image to a set of intraoperative fluoroscopic images. The key problem in 2D-3D registration is to define an accurate similarity metric between the 2D and 3D data, and choose an appropriate optimization algorithm. Various similarity metrics and optimization algorithms have been proposed for 2D-3D registration; however, current techniques have several critical limitations. First, a good initial guess - usually within a few millimetres from the true solution - is required, and such capture range is often not wide enough for clinical use. Second, for currently used optimization algorithms, it is difficult to achieve a good balance between the computation efficiency and registration accuracy. Third, most current techniques register a 3D image of a single bone to a set of fluoroscopic images, but in many CAOS procedures, such as a multi-fragment fracture treatment, multiple bone pieces are involved. In this thesis, research has been conducted to investigate the above problems: 1) two new registration techniques are proposed that use recently developed optimization techniques, i.e. Unscented Kalman Filter (UKF) and Covariance Matrix Adaptation Evolution Strategy (CMA-ES), to improve the capture range for the 2D-3D registration problem; 2) a multiple-object 2D-3D registration technique is proposed that simultaneously aligns multiple 3D images of fracture fragments to a set of fluoroscopic images of fracture ensemble; 3) a new method is developed for fast and efficient construction of anatomical atlases; and 4) a new atlas-based multiple-object 2D-3D registration technique is proposed to aid fracture reduction in the absence of preoperative 3D images. Experimental results showed that: 1) by using the new optimization algorithms, the robustness against noise and outliers was improved, and the registrations could be performed more efficiently; 2) the simultaneous registration of multiple bone fragments could achieve a clinically acceptable global alignment among all objects with reasonable computation cost; and 3) the new atlas construction method could construct and update intensity atlases accurately and efficiently; and 4) the use of atlas in multiple-object 2D-3D registration is feasible. / Thesis (Ph.D, Computing) -- Queen's University, 2011-09-28 10:58:04.406

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

Master of Science in Veterinary Science / Developmental Orthopaedic Disease (DOD) describes problems affecting the limbs of young horses, including abnormal bone, joint and tendon development. DOD is responsible for major economic losses in the Thoroughbred industry. Investigation into the epidemiology of DOD in Australia and Ireland as described in this thesis has allowed valuable comparisons and recommendations to be made between the studs in these countries. The project described in this thesis commenced in 1999, with the aim to: a) Establish the incidence of DOD on a stud in Australia and to compare this with similar data for a stud in Ireland b) To determine relationships between factors affecting severity and incidence of DOD in foals with respect to the country in which they are bred and raised c) To further identify risk factor areas associated with the development of DOD Records of 1717 mares from a major stud in Ireland and another in Australia were made available. Foal weight, age of mare, condition of mare, foal sire and date of birth were monitored over two years. The occurrence of DOD was recorded against these data. The incidence of DOD was found to be higher on the stud in Australia (average 49.85%) than on the stud in Ireland (average 14%). Foal weight was found to be a significant factor affecting DOD, with heavier foals showing a proportionally higher severity of the problem. The Australian stud had a higher incidence of DOD in 2000 compared to 1999 (65.2% affected vs 32.1% in 1999), whereas the Irish stud had a lower incidence in 1999 compared to 2000 (11.8% affected vs 16.2% in 2000). The dramatic increase in the incidence of DOD in Australian foals over the 1999-2000 period is representative of the increase in a major problem in the industry, as well as greater awareness of the problem over recent years. It highlights the urgent need for further research into understanding the cause(s) of DOD. Overall recommendations arising from the study include that a large scale, long term study be undertaken in Australia. Further investigation into the nutrition of horses in Ireland and Australia would be of great usefulness in understanding DOD, as would possible genetic links. An issue requiring attention is that of developing a standard definition of the disorder. Considering the wide range of disorders which may fit under the umbrella term DOD, a clear definition is of great importance. The incidence of DOD on one large farm in Ireland was found to be currently low and stable relative to its another large stud farm in Australia. This is a significant finding as the genetic pool of the horses share similarities on both farms, particularly as stallions shuttling between hemispheres sire many foals on both farms. Thus, the data provided herein provide an excellent basis for further valuable comparative studies investigating DOD in foals with a similar genetic background but subjected to differing environmental conditions.

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